We have talked about bringing out compensations and asymmetries in gait patterns by adding a novel stimulus to the exam, like having the client/patient put their hands over their heads, or close their eyes. Here is yet another tool for your toolbox: having the client walk backwards.
Both forward and backward walking share pattern generation control circuits in the brainstem, providing similar (though reversed) kinematic patterns. Backward walking requires different muscle activation sequences which can highlight subtle gait asymmetries, particularly in individuals that have cortical impairment (like the kids with cerebral palsy in this paper) or perhaps people with more subtle cortical impairments, like cerebellar dysafferentation from abnormal joint and muscle mechanoreceptor input and integration. Don’t believe us or what the study says, try it on yourself! It can be a humbling experience : )
In part, the study concludes: “The observed spatiotemporal asymmetry assessments may reflect both impaired supraspinal control and impaired state of the spinal circuitry.”
The next time you are having a difficult time seeing something in an evaluation, or are trying to bring out an asymmetry, in addition to your other tricks, have them walk backwards.
Cappellini G, Sylos-Labini F, MacLellan MJ, Sacco A, Morelli D, Lacquaniti F, Ivanenko Y. Backward walking highlights gait asymmetries in children with cerebral palsy. J Neurophysiol. 2018 Mar 1;119(3):1153-1165. doi: 10.1152/jn.00679.2017. Epub 2017 Dec 20.